As new hospital reimbursement schemes are rapidly introduced into the hospital industry, the impact of cost containment measures will be felt by all departments of pharmacy. This paper describes how the pharmacy department at one community teaching hospital justified the continuation of clinical pharmacy programs when faced with an immediate 18% reduction in pharmacist staff. Various written communications and recommendations are provided to assist other hospital pharmacy departments that are facing or may face this dilemma.

Cost Control↗

PubMed1985

Wrongful discharge of the at-will hospital pharmacy employee.

The vast majority of hospital pharmacy employees are not covered by a contract or a collective bargaining agreement and are therefore subject to the employment at-will doctrine. In recent years, there has been considerable erosion of this doctrine with increased protection of the at-will employee from wrongful discharge. This paper reviews both the statutory and judicial limits on the right to discharge an employee at-will, and discusses the implications for pharmacy management and staff. Although the laws relating to wrongful discharge will vary from state to state, the changing theories governing this process are of significant importance to all concerned.

Employment↗

PubMed1985

The future of hospital pharmacy residencies and clinical training programs.

Explore the source record for details and available documents.

Education, Pharmacy↗

PubMed1985

Development of a pocket ruler as a guide to selected drug therapy.

This article describes the development of a durable, plastic "pocket ruler as a guide to selected drug therapy." The "pocket guide" was developed to provide comprehensive antibiotic cost-related information about parenteral antibiotics that may aid the prescriber in drug therapy selection. Additionally, the pocket guide provides clinical information and a listing of available pharmacy services that could be useful to prescribers and other health-care professionals.

Cost Control↗

PubMed1985

Outcome of patients treated by an aminoglycoside pharmacokinetic dosing service.

Differences in outcome between patients whose aminoglycoside dosing regimens were individualized by a clinical pharmacokinetic dosing service (CPDS) and patients who did not receive CPDS consultation were evaluated by retrospective chart review. Data for a number of dependent variables that might affect patient outcome were collected from the medical records of 42 patients with culture-proven gram-negative pneumonia or sepsis who had received CPDS dosing consultations and 60 similar patients who had not received CPDS consultations. Data were also collected for a number of analytical and categorical independent variables to evaluate sources of variation between the groups. Variables were compared using both parametric and nonparametric statistical tests. For patients whose dosing regimens had been individualized by the CPDS, length of aminoglycoside therapy and length of stay were significantly shorter, changes in serum creatinine concentration from baseline were significantly smaller, and mortality was significantly lower; morbidity was reduced by significantly fewer incidences of aminoglycoside nephrotoxicity. Significant differences existed between the mean dosing intervals, mean numbers of serum aminoglycoside concentration determinations, and mean baseline serum creatinine concentrations for the two groups. Although a favorable difference in patient outcome was demonstrated for patients whose dosing regimens were individualized by the CPDS, unmeasurable differences between the two groups of patients make it difficult to attribute the difference solely to the effect of the dosing service.

Adolescent↗

PubMed1984

A strategy to reduce drug expenditures with a drug utilization review program.

This paper describes a potential strategy for implementing a Drug Utilization Review (DUR) program aimed at reducing hospital drug expenditures. The importance of this type of program is underscored by the spiraling rise in health care expenditures and the influence of a new drug technology on this rise. The program described here consists of a utilization review program for high cost drugs for which a lower cost alternative exists. An initial retrospective usage and cost analysis must be undertaken to identify those drugs which should be reviewed initially. As the DUR program progresses, additional drugs can be added to the review program. Once the drugs to be reviewed are identified, the first step is to develop usage criteria. This can be accomplished through a review of the literature and consultation with medical and other specialists. Appropriate medical administrative staff approval and endorsement of the criteria should be obtained utilizing various committee structures and other input. The pharmacy staff must also be inserviced on the approved drug usage criteria. After the criteria are finalized, staff pharmacists will contact a DUR pharmacist daily upon receipt of any physician orders for the review drugs. This pharmacist will then compare the prescribed drug use to the approved criteria and contact the prescriber when the usage appears questionable. A lower cost therapy will then be recommended when appropriate. In order to assess the impact of this intervention strategy on drug expenditures, the cost of the initially prescribed therapies must be compared to the recommended therapies. Data should also be obtained on overall drug usage and expenditures to detect shifts in therapy and drug costs. The success or failure of this concurrent DUR program will be highly dependent upon a team approach and cooperation. A program of this type could have a significant impact on hospital drug expenditures in those hospitals where it can be successfully implemented.

Cost Control↗

PubMed1984

Multidisciplinary quality assessment of a unit dose drug distribution system.

A two-part multidisciplinary study was performed at a 531-bed community hospital to evaluate the unit dose drug distribution system. The first study identified the relative incidence of medication discrepancies between nursing administration records and what actually was delivered for the patient. The second study revealed the incidence of scheduled medications which were returned to the pharmacy unused. In both studies, the reason for each disparity was noted and tabulated. The results of each study were reviewed and specific corrective measures were developed for each problem area detected. Follow-up programs were also recommended to determine the effectiveness of the corrective measures. Other hospitals with unit dose systems may find these study results revealing and useful in evaluating their own distribution services.

Hospital Bed Capacity, 500 and over↗

PubMed1984

Perspectives on the hospital formulary.

The hospital formulary system will become increasingly important in future years with the transition to target-rate third party reimbursement. This paper provides an overview of the hospital formulary and its management. A brief history of the formulary system is provided along with some key definitions. The potential benefits and actual effectiveness of a formulary system are described. Various potential problems in managing a hospital formulary are identified along with recommendations to minimize their occurrence.

Formularies, Hospital as Topic↗